The Treatment Trap

When it comes to health care, more is not always better. That’s the message of “The Treatment Trap,” which argues that overuse (defined as providing a treatment when its risk of harm exceeds its potential benefit) is a growing phenomenon in American healthcare, one that threatens the health (and pocketbook) of uninformed consumers.

Of course, from a patient’s perspective it can be difficult to discern what constitutes appropriate treatment and what might be inappropriate. But as the authors point out, one needless test can trigger an avalanche of additional tests, and an unnecessary surgery can cause pain and inconvenience, not to mention expose the patient to the possibility of infection and complications. Heart bypass surgery, back surgery, ear tube surgery in children, and CT scans are among the procedures identified as most overused.

Gibson and Singh point to the fee-for-service method of reimbursing doctors as contributing to the problem, as it provides an open-ended invitation for abuse. This isn’t to say the authors are accusing physicians of being anything less than well-intentioned; no doubt the overwhelming majority of doctors have the best interests of their patients in mind. But combined with the “Do something” mentality of both physicians and patients (and the relative ease of performing and recovering from surgery), it has arguably become too easy to order invasive, expensive procedures.

According to the authors, the problem of overuse won’t be easy to overcome, because doctors do not usually interfere in other doctors’ business, and because politicians are loath to take on hospitals, doctors, and medical device and supply companies, who stand to lose income if overuse is curtailed. Other obstacles on the physician side include the enthusiasm factor (when doctors become passionate advocates for the services they provide rather than objective caregivers), and the perfectly understandable fear of missing a diagnosis.

In the penultimate chapter, Gibson and Singh set forth a ten-step plan to halt the overuse of medical care. Among other things, they propose giving health insurance discounts to informed patients and rating hospitals on how well they explain treatment options. Finally, in the last chapter, they identify “Twenty smart ways to protect yourself,” providing practical suggestions for learning about treatment options, for instance. In other words, don’t live and learn; instead learn and live.